CoverMyMeds provides a no-cost digital resource for submitting prior authorization (PA) forms for many specialty drugs covered under most drug plans. Call 1-866-452-5017 or visit
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Along with support from CoverMyMeds, you can download the instructions and templates below for helpful guidelines and tips for navigating the prior authorization process.
This information is for informational purposes only and is not intended to provide reimbursement or legal advice. The information presented here does not guarantee payment or coverage.
*Terms and Conditions apply. This benefit covers ORILISSA® (elagolix). Eligibility: Available to patients with commercial insurance coverage for ORILISSA who meet eligibility criteria. Co-pay assistance program is not available to patients receiving reimbursement under any federal, state, or government-funded insurance programs (for example, Medicare [including Part D], Medicare Advantage, Medigap, Medicaid, TRICARE, Department of Defense, or Veterans Affairs programs) or where prohibited by law or by the patient’s health insurance provider. If at any time a patient begins receiving drug coverage under any such federal, state, or government-funded healthcare program, patient will no longer be able to use the ORILISSA Savings Card and patient must call 1-800-ORILISSA (1-800-674-5477) to stop participation. Patients residing in or receiving treatment in certain states may not be eligible. Patients may not seek reimbursement for value received from the ORILISSA Savings Card Program from any third-party payers. Offer subject to change or discontinuation without notice. Restrictions, including monthly maximums, may apply. Subject to all other terms and conditions, the maximum annual benefit that may be available solely for the patient’s benefit under the co-pay assistance program is $5,000 per calendar year. The actual application and use of the benefit available under the co-pay assistance program may vary on a monthly, quarterly, and/or annual basis depending on each individual patient’s plan of insurance and other prescription drug costs. This assistance offer is not health insurance. By redeeming this card, you acknowledge that you are an eligible patient and that you understand and agree to comply with the terms and conditions of this offer. To learn about AbbVie’s privacy practices and your privacy choices, visit https://privacy.abbvie
ORILISSA® (elagolix) is indicated for the management of moderate to severe pain associated with endometriosis.
These are not all the possible side effects of ORILISSA.
Safety and effectiveness of ORILISSA in patients less than 18 years of age have not been established.
US-ORIL-200330
For more information, please click here for full Prescribing Information.
1. ORILISSA [package insert]. North Chicago, IL: AbbVie Inc.
ORILISSA® (elagolix) is indicated for the management of moderate to severe pain associated with endometriosis. Limit the duration of use based on the dose and coexisting condition.
These are not all the possible side effects of ORILISSA.
Safety and effectiveness of ORILISSA in pediatric patients have not been established.
US-ORIL-210045
For more information, please click here for full Prescribing Information.
1. ORILISSA [package insert]. North Chicago, IL: AbbVie Inc.
Co-primary endpoint: Responder rate for dysmenorrhea at month 31,3*
ELARIS EM-2
P≤0.001 vs placebo
Secondary endpoints: Mean dysmenorrhea score reduction from baseline to month 6 (ranked) and mean percent reduction over 6 months (non-ranked)1,3,4,6†
Mean baseline dysmenorrhea score: 2.2 (on a scale from 0 to 3)
Mean change in pain score from baseline to month 6 was a ranked secondary endpoint. All other endpoints shown above were non-ranked secondary endpoints and multiplicity adjustments were not applied.
*Assessed from baseline to the analysis month greater or equal to the following calculated, threshold of improvement in pain score in each study: Dysmenorrhea responder thresholds were ≥0.81-point decrease from baseline in ELARIS EM-1 and ≥0.85-point decrease from baseline in ELARIS EM-2. NMPP responder thresholds were ≥0.36-point decrease from baseline in ELARIS EM-1 and ≥0.43-point decrease from baseline in ELARIS EM-2. The threshold was determined based on analysis of the change in pain score corresponding to "much improved" or "very much improved" on the Patient Global Impression of Change Questionnaire.
†Baseline and monthly visit values were based on a 35-day mean.
*Dysmenorrhea responder threshold was ≥0.81-point decrease from baseline in ELARIS EM-1 and ≥0.85-point decrease from baseline in ELARIS EM-2. NMPP responder threshold was ≥0.36-point decrease from baseline in ELARIS EM-1 and ≥0.43-point decrease from baseline in ELARIS EM-2.
†In ELARIS EM-1 and EM-2, the mean changes in dysmenorrhea and NMPP scores from baseline to month 6 were secondary endpoints.
‡In ELARIS EM-1 and EM-2, the mean changes in dysmenorrhea and NMPP scores from baseline to each month (except month 6) were non-ranked secondary endpoints. Appropriate multiplicity adjustments were not applied.
§Baseline and monthly visit values were based on a 35-day mean.
Secondary endpoints: Mean dyspareunia score reduction from baseline to month 3 (ranked) and mean percent reduction over 3 months (non-ranked)1,3,4,6*
Mean baseline dyspareunia score: 1.5 (on a scale from 0 to 3)
Mean change in pain score from baseline to month 3 was a ranked secondary endpoint. All other endpoints shown above were non-ranked secondary endpoints and multiplicity adjustments were not applied.
*Baseline and monthly visit values were based on a 35-day mean.
Co-primary endpoint: Responder rate for NMPP at month 31,3*
ELARIS EM-2
P≤0.01 vs placebo
Secondary endpoints: Mean NMPP score reduction from baseline to month 6 (ranked) and mean percent reduction over 6 months (non-ranked)1,3,4,6†
Mean baseline NMPP score: 1.6 (on a scale from 0 to 3)
Mean change in pain score from baseline to month 6 was a ranked secondary endpoint. All other endpoints shown above were non-ranked secondary endpoints and multiplicity adjustments were not applied.
*Assessed from baseline to the analysis month greater or equal to the following calculated, threshold of improvement in pain score in each study: Dysmenorrhea responder thresholds were ≥0.81-point decrease from baseline in ELARIS EM-1 and ≥0.85-point decrease from baseline in ELARIS EM-2. NMPP responder thresholds were ≥0.36-point decrease from baseline in ELARIS EM-1 and ≥0.43-point decrease from baseline in ELARIS EM-2. The threshold was determined based on analysis of the change in pain score corresponding to "much improved" or "very much improved" on the Patient Global Impression of Change Questionnaire.
†Baseline and monthly visit values were based on a 35-day mean.
Co-primary endpoint: Responder rate for NMPP at month 31,3*
ELARIS EM-2
P≤0.001 vs placebo
Secondary endpoints: Mean NMPP score reduction from baseline to month 6 (ranked) and mean percent reduction over 6 months (non-ranked)1,3,4,6†
Mean baseline NMPP score: 1.6 (on a scale from 0 to 3)
Mean change in pain score from baseline to month 6 was a ranked secondary endpoint. All other endpoints shown above were non-ranked secondary endpoints and multiplicity adjustments were not applied.
*Assessed from baseline to the analysis month greater or equal to the following calculated, threshold of improvement in pain score in each study: Dysmenorrhea responder thresholds were ≥0.81-point decrease from baseline in ELARIS EM-1 and ≥0.85-point decrease from baseline in ELARIS EM-2. NMPP responder thresholds were ≥0.36-point decrease from baseline in ELARIS EM-1 and ≥0.43-point decrease from baseline in ELARIS EM-2. The threshold was determined based on analysis of the change in pain score corresponding to "much improved" or "very much improved" on the Patient Global Impression of Change Questionnaire.
†Baseline and monthly visit values were based on a 35-day mean.
